Diagnostic Laparoscopy Flashcards
The overall risk of serious complications from diagnostic laparoscopy is approx __ in 1000 women
2 in 1000 women
This includes damage to bowel, bladder, ureters, uterus or major blood vessels which would require immediate repair by laparoscopy or laparotomy
What percentage of bowel injuries may not be diagnosed at time of laparoscopy?
Up to 15%
What is the risk of hernia at site of entry?
Less than 1 in 100; uncommon
What is the risk of death?
3-8 in 100,000 women (very rare)
What are serious risks of laparoscopy?
The overall risk of serious complications from diagnostic laparoscopy is approximately 2 in 1000 women
(uncommon).This includes damage to the bowel, bladder, ureters, uterus or major blood vessels which
would require immediate repair by laparoscopy or laparotomy (open surgery is uncommon). However, up
to 15% of bowel injuries might not be diagnosed at the time of laparoscopy.
● Failure to gain entry to the abdominal cavity and to complete the intended procedure.
● Hernia at site of entry (less than 1 in 100; uncommon).
● Thromboembolic complications (rare or very rare).
● Death; 3–8 in 100 000 women (very rare) undergoing laparoscopy may die as a result of complications.
What 4 frequent risks may occur after laparoscopic surgery?
- bruising
- shoulder - tip pain
- wound gaping
- infection
Approximately ________ women undergo laparoscopic surgery in the UK each year.
250 000
What is the Veress needle entry technique?
The abdominal cavity is insufflated with carbon dioxide gas before introduction of the
primary trocar and cannula; also called the closed laparoscopic technique
What is the Hasson or open entry?
This method uses a small incision to enter
the peritoneal cavity under direct vision
How should the closed laparoscopic entry technique be performed?
- The primary incision for laparoscopy should be vertical from the base of the
umbilicus - The operating table should be horizontal
- The lower abdominal wall should be stabilised in such a way that the Veress needle can be inserted at right angles to the skin and should be pushed in just sufficiently to penetrate the fascia and the peritoneum. Two audible clicks are usually heard as these layers are penetrated.
What should the initial insufflation pressure be?
Low - <8mmHg
What intra-abdominal pressure should be achieved to safely insert the primary trocar?
20-25mmHg
this results in increased splinting and allows the trocar to be more easily inserted through the layers of the abdominal wall; associated with a lower risk of major vessel injury
What should the distension pressure be reduced to once the insertion of the trocars are complete?
12-15mmHg
This gives adequate distension for operative laparoscopy and allows the anaesthetist to ventilate the
patient safely and effectively.
Where should the primary trocar be inserted ?
The primary trocar should be inserted in a controlled manner at 90 degrees to the skin, through the incision at the thinnest part of the abdominal wall, in the base of the umbilicus.
Then should rotate through 360 degrees to check for adherent bowel.
What would you do if after insertion of the primary tracer, there is concern that bowel may be adherent under the umbilicus?
the primary trocar site should
be visualised from a secondary port site, preferably with a 5-mm laparoscope.
What is the rate of adhesion formation at the umbilicus following midline laparotomy and low transverse incision?
up to 50% following midline laparotomy
and 23% following low transverse incision
Where is Palmer’s point?
3 cm below the left costal margin in the mid-clavicular line
How should secondary ports be inserted?
Under direct vision, perpendicular to the skin, maintaining pneumoperitoneum at 20-25mmHg;
Visualise inferior epigastric vessels to ensure entry point is away from the vessels;
once the tip of the trocar has pierced the peritoneum it should be angled towards the anterior pelvis under careful visual control until the sharp tip has been removed
What is the origin of the inferior epigastric artery?
The inferior epigastric artery (IEA) arises from the external iliac artery, proximal to the inguinal ligament.
What specific measures are required for laparoscopic surgery in the obese woman?
The open (Hasson) technique or entry at Palmer’s point are recommended for the primary entry in
women with morbid obesity.
What specific measures are required for laparoscopic surgery in the woman who is very thin?
The Hasson technique or insertion at Palmer’s point is recommended for the primary entry in women who are very thin.
The aorta may lie less than ____ cm below the skin in very thin women
2.5cm
